Department of Neurology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Clin Appl Thromb Hemost. 2022 Jan-Dec;28:10760296221121287. doi: 10.1177/10760296221121287.
Investigations on coagulation parameters including fibrinogen (Fbg), fibrinogen degradation products (FDP), and D-dimer in ischemic stroke patients treated with intravenous thrombolysis are insufficient. We aimed to investigate the association between in-hospital clinical outcomes and the coagulation parameters at different time points in ischemic stroke patients treated with intravenous tissues plasminogen activator (IV tPA).
We retrospectively enrolled patients who received IV tPA therapy within 4.5 h from symptoms onset. Demographics, clinical characteristics, imaging measures, and the discharge mRS score were collected. Multivariable logistic regression analyses were performed to test whether coagulation parameters were independent predictors for the in-hospital clinical outcomes. We also employed machine learning models to investigate whether coagulation parameters were able to improve the prediction of favorable functional outcomes.
One hundred and fifty-two patients treated with IV tPA were included. Among the coagulation parameters, low D-dimers at 48 h proved to be an independent predictor of favorable functional outcome (adjusted odd ratio 0.24, 95% confidential intervals 0.06-0.92, P = 0.04). The AUC of D-dimer at 48 h to predict favorable functional outcome was 0.73 (0.60-0.87) and the optimal cut-off value was 0.92 (sensitivity 0.69, specificity 0.78). Machine learning models with D-dimer at 48 h had superior performance in predicting favorable functional outcomes and among the input variables in the machine learning models, D-dimer at 48 h showed the highest weight in predicting mRS 0-1 at discharge (38.44%).
Increased levels of D-dimer at 48 h was associated with lower proportion of favorable functional outcomes in acute ischemic stroke patients with intravenous thrombolysis.
接受静脉溶栓治疗的缺血性脑卒中患者的凝血参数（包括纤维蛋白原[Fbg]、纤维蛋白原降解产物[FDP]和 D-二聚体）研究不足。我们旨在研究接受静脉组织型纤溶酶原激活剂（IV tPA）治疗的缺血性脑卒中患者不同时间点凝血参数与住院临床结局之间的关系。
我们回顾性纳入了症状发作后 4.5 小时内接受 IV tPA 治疗的患者。收集了人口统计学、临床特征、影像学测量值和出院 mRS 评分。多变量逻辑回归分析用于检验凝血参数是否为住院临床结局的独立预测因子。我们还采用机器学习模型来研究凝血参数是否能够提高对良好功能结局的预测能力。
共纳入 152 例接受 IV tPA 治疗的患者。在凝血参数中，48 小时时低 D-二聚体被证明是良好功能结局的独立预测因子（调整后比值比 0.24，95%置信区间 0.06-0.92，P=0.04）。D-二聚体在 48 小时预测良好功能结局的 AUC 为 0.73（0.60-0.87），最佳截断值为 0.92（灵敏度 0.69，特异性 0.78）。具有 48 小时 D-二聚体的机器学习模型在预测良好功能结局方面表现出更好的性能，并且在机器学习模型的输入变量中，48 小时 D-二聚体在预测出院时 mRS 0-1 方面具有最高的权重（38.44%）。
急性缺血性脑卒中患者静脉溶栓后 48 小时 D-二聚体水平升高与良好功能结局比例降低相关。
